Telehealth Experience Among Patients With Limited English Proficiency

This cross-sectional study assesses the implication of patients’ English language skills for telehealth use and visit experience.


Introduction
Patients with limited English proficiency (LEP) face disparities in using telehealth. 1 While research has focused on access, attention to patient experience is essential.Patients with LEP have worse experience with in-person care. 2 We examined differences in telehealth access and experience between patients with LEP and patients with English proficiency (EP) in California.

Methods
We analyzed the 2021 adult data from California Health Interview Survey (CHIS), which is conducted in 6 languages. 3The Brigham and Women's Hospital Institutional Review Board deemed this crosssectional study exempt from review and waived informed consent because publicly available data were used.We followed the STROBE reporting guideline.
Study exposure was LEP, defined as speaking English not well or not at all.Study outcomes were telehealth use and visit experience.For telehealth use, CHIS participants were asked whether they had used video or telephone telehealth in the past 12 months (eAppendix in Supplement 1).For visit experience, participants were asked to compare their experience with video or telephone visits to in-person visits.We dichotomized visit experience to better or same vs worse.Outcomes of patients with LEP or EP were assessed and compared.Covariates included factors associated with use of digital tools: age, sex, marital status, insurance status, educational level, poverty level, health status, internet use, and having usual source of care. 1,4Self-reported race and ethnicity and metropolitan area residency were excluded due to collinearity.
We performed bivariable comparisons using weighted χ 2 analysis.We then performed weighted multivariable logistic regression to ascertain odds of worse experience after controlling for covariates.We used survey-supplied replicate weights to produce population estimates, as recommended by CHIS. 3 Weights represent California's residential population.Two-sided P < .05 was considered significant.Analyses were performed using R 3.6.2(R Core Team).
In unadjusted analyses, patients with LEP were less likely to report either video or telephone telehealth use (37% vs 50%; P < .001).In adjusted analyses, patients with LEP were less likely to report video or telephone telehealth use (odds ratio [OR], 0.63; 95% CI, 0.52-0.77;P < .001)vs patients with EP (Table 2).For video visits, in unadjusted analyses, patients with LEP reported worse experience (32% vs 26%; P = .04)vs patients with EP.In adjusted analyses, patients with LEP were

+ Supplemental content
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Open Access.This is an open access article distributed under the terms of the CC-BY License.).For telephone visits, there was no difference in visit experience between the 2 groups (unadjusted: 29% vs 31%, P = .60;adjusted: OR, 1.24 [95% CI, 0.91-1.69],P = .17).

Table 1 .
Characteristics of Survey Participants With Video and Telephone Visits by English Proficiency (continued) b Race and ethnicity were self-reported in the survey.cOtherincluded non-Hispanic Black, American Indian or Alaskan Native, and other or 2 or more races.

Table 2 .
Telehealth Use and Visit Experience vs In-Person Visits by English Proficiency Adjusted for age, sex, marital status, insurance status, educational level, poverty level, health status, internet use, and having usual source of care. b